Cleveland Clinic, Cleveland, Ohio, USA.
J Am Soc Echocardiogr. 2011 Sep;24(9):1046-55. doi: 10.1016/j.echo.2011.05.014. Epub 2011 Jul 1.
Computed tomography (CT) is the gold standard for assessing pulmonary vein (PV) anatomy and stenosis after ablation for atrial fibrillation (AF), but radiation exposure can be a concern. Transesophageal echocardiography (TEE) provides anatomic and functional assessment of the PVs, although no study has prospectively compared findings on TEE with those on CT.
The Role of Transesophageal Echocardiography Compared to Computed Tomography in Evaluation of Pulmonary Vein Ablation for Atrial Fibrillation (ROTEA) study was a prospective, single-blinded observational study of patients with paroxysmal or persistent AF undergoing ablation. TEE and CT were performed immediately before and 3 months after AF ablation. The study included 43 patients (84% men; mean age, 56 ± 11 years).
In the preprocedural study, TEE identified 98% of PVs with adequate Doppler measurements obtained. After ablation, no moderate or severe PV stenosis was detected on CT, and a 30% to 50% reduction in luminal diameter was seen in 5% of studied veins. Functional PV stenosis by pulsed-wave Doppler was seen in two veins on TEE. PV diameters decreased after ablation by 0.20 ± 0.03 and 0.22 ± 0.03 cm as measured by CT and TEE, respectively (P < .001). However, TEE underestimated PV ostial dimensions compared with CT, especially for the inferior PVs. Severe spontaneous echo contrast and low left atrial appendage emptying velocities, were identified in 10% of patients in sinus rhythm after ablation.
In the ROTEA study, TEE was feasible in assessing PVs before and after ablation, providing both anatomic and functional information that complemented CT. PV ostial dimensions after ablation can be monitored using either modality, although TEE underestimates PV dimensions, especially for the inferior veins.
计算机断层扫描（CT）是评估房颤（AF）消融后肺静脉（PV）解剖结构和狭窄的金标准，但辐射暴露可能是一个问题。经食管超声心动图（TEE）提供了 PV 的解剖和功能评估，但尚无研究前瞻性比较 TEE 与 CT 的发现。
经食管超声心动图在评估房颤消融中的作用与计算机断层扫描的比较（ROTEA）研究是一项前瞻性、单盲观察性研究，纳入了接受消融治疗的阵发性或持续性 AF 患者。TEE 和 CT 分别在 AF 消融术前和术后 3 个月进行。该研究纳入了 43 名患者（84%为男性；平均年龄 56±11 岁）。
在术前研究中，TEE 可识别 98%的 PV，并获得足够的多普勒测量值。消融后，CT 未发现中重度 PV 狭窄，5%的研究静脉可见管腔直径缩小 30%至 50%。TEE 显示两个静脉存在脉冲波多普勒测量的功能性 PV 狭窄。消融后，CT 和 TEE 分别测量 PV 直径缩小了 0.20±0.03cm 和 0.22±0.03cm（P<0.001）。然而，TEE 较 CT 低估了 PV 口部的尺寸，尤其是下 PV。消融后窦性心律的 10%患者存在严重的自发性回声对比和左心耳排空速度低。
在 ROTEA 研究中，TEE 可用于评估消融前后的 PV，提供解剖和功能信息，与 CT 相辅相成。可使用任一方法监测消融后 PV 口部的尺寸，但 TEE 低估了 PV 尺寸，尤其是下 PV。
